HIPPAA and Privacy
What does HIPAA stand for?
Health Insurance Portability and Accountability Act
What does the False Claims Act prohibit?
Submitting false or fraudulent claims to the government for payment
What law grants patients the right to access their own medical records?
HIPAA
What is ICD-10 used from in healthcare?
Coding and classifying diagnoses and health conditions.
What does the term "conflict of interest" mean in healthcare?
A situation where personal interests could interfere with professional duties
Which type of data is protected under HIPAA?
Protected Health Information (PHI)
What is the Stark Law designed to prevent?
Physician self-referral for certain health services when there is a financial relationship.
What is informed consent?
The process of explaining treatment options and risks before a patient agrees to it.
What is the purpose of CPT codes?
To describe medical, surgical, and diagnostic procedures and services.
What is the purpose of a code of Conduct in a healthcare organization?
To outline ethical standards and expectations for behavior.
What does the "minimum necessary" rule require under HIPAA?
To only use or disclose the minimum amount of PHI needed for a specific purpose
Which agency is primarily responsible for investigation healthcare fraud?
Office of Inspector General (OIG)
What rights do patients have regarding the refusal of treatment?
Patients have the right to refuse treatment,even if it is life-sustaining.
What is upcoding?
Billing for a more expensive service than the one provided.
What is whistleblowing in the context of healthcare compliance?
Reporting illegal or unethical behavior within an organization.
Who enforces HIPAA regulations?
The Office for Civil Rights (OCR) within the Department of Health and Human Services (HHS)
What does the Anti-Kickback Statute prohibit?
Offering, paying, soliciting, or receiving anything of value to induce or reward referrals.
What is the purpose of the Patient Self-Determination Act (PSDA)?
To inform patients of their rights regarding advance directives and medical decision-making.
What does the term "medical necessity" refer to?
Justifying that a service or procedure is needed for patient care.
What is the significance of non-retaliation policies in healthcare?
They protect employees who report compliance concerns from retaliation.
What are two common types of HIPAA violations?
Unauthorized access to PHI and failure to secure data
What are civil monetary penalties (CMPs) in the context of healthcare fraud?
Fines imposed for violations like false claims, kickbacks, and Stark Law violations.
Name two types of advance directives.
Living will and durable power of attorney for heath care.
What is a National Provider Identifier (NPI) used for?
A unique identification number for covered healthcare providers for billing and administrative purposes.
What is the significance of non-retaliation policies in healthcare?
They protect employees who report compliance concerns from retaliation.